Book reviews

This volume, edited by J. W. Eaton, Diane K. Konzen and James G. White of Minneapolis, Minnesota, contains 67 contributions by internationally renowned biochemists, geneticists, physical chemists and haematologists, which were presented at a conference held in Minneapolis in SeptembeL 1984. The intention was to allow the red blood cell to serve as a model for numerous molecular and cellular ageing processes of living cells; their ready availability and the possibility of examining both in vivo and in vitro altered cells renders them a particularly suitable subject of study for this purpose. Research on erythrocytes embraces alterations in structural proteins, membranes, and erythrocyte enzymes, and enzymatically induced changes in and elimination of ageing cells. The sessions of the conference have been arranged into seven chapters, which include treatments of general aspects of cellular differentiation, maturation and ageing, agerelated changes of the red cell membrane and its destruction, changes in the cellular enzymes and comparative aspects during erythrocyte ageing in various species such as mammals and birds. Additionally some special topics are treated, such as alterations in the cytoskeleton of ageing platelets, the roles of aspartie acid and asparagine in the proteins of ageing erythrocytes, the biphasic loss of blood cell activity during in vivo ageing, changes in the phospholipids of the red cell membrane in various haemolytic anaemias, sickle cell anaemias and thalassaemias, the acceleration of red cell ageing and loss in heriditary drug-induced haemolytic anaemias, and the ageing and sequestration of red cells from the circulation. This volume will be of great scientific value to haematologists, biologists and biochemists, but also gerontologists who are concerned with the cellular forerunners of the ageing process will find much to interest them. In this respect the human erythrocyte presents an outstanding in vivo model. There is at the present time no other survey in the world literature where the in vivo ageing of blood cells has been so intensively studied: the book can be recommended unreservedly. G.W. LOhr, Freiburg

THE title of this work is the most interesting one that can be given to a medical essay. What can more certainly and forcibly engage the attention of every physician, than a dissertation on the means of lessening the pain and danger of child-birth ? The fatality of this state, although not so extensive at present as it was a century or two since, when it was chiefly superintended by female practitioners, is still dreadful. Every attempt, therefore, to lessen its danger, either by a relation of the results of fortunate experience, or by speculative reasoning, must be respectively received with the warmest gratification, and examined with the most assiduous care; though it must be acknowledged that the practice of medicine has not often been directly benefitted by prolusions of the latter kind. The es.?ay of Dr. Dewees comprises matter possessing both of the above characters.
Before we enter into the consideration of the author's view of the proximate causes of the pain and danger of child-birth peculiar to ?women of civilized life, let us, since speculations on it are now to be indulged, adduce a sketch of that which we have ourselves taken of this subject; not from slight and casual consideration, but from ropeated and serious attention.
Dr. Dcavccs on the Pain and Difficulty of  SB'flfer (he clangers to which we have just alluded; whilst Other tribes of the same race, remaining in the state of barbarism, encounter the act of parturition without either grief or fear, although no remarkable difference of formation is evident. This is witnessed in the Tartars and in the Chinese. In the ruder tribes of the former, the female joins the progress of her horde immediately after delivery ; whilst the sufferings of the latter on the same occasion are hardly inferior to those of the most delicate European. The Chinese husband may now take to his bed oh the birth of his child, but he does not find his wife able to attend on him with the pampering luxuries he then, from custom, may require. It is common at present, in some of the more retired parts of Ireland, for the women who dwell in huts formed only of stone-walls, a thatched-roof, and a door ; in which the only furniture is an iron pot, a few knives, and some wooden bowls; containing neither chair, table, bed, nor altar of the Penates ;?and who, passing their lives with so little about them to excite variety of ideas, are iu such a state of non-intellectuality, that they seem to be guided by what in brutes is termed pure instinct;?it is common for those females to appear without their cabins within a few hours after their delivery, which they have quietly undergone, without fear and without trouble.
But, is it thus with those of their countrywomen who inspired their own Anacreon with those ideas of sentimental refinement that are the acm6 of human feeling?
It is not, then, to anatomical formation, but to physiology, that we must look for the explanation of this phenomenon.
An ancient philosopher, whose profound wisdom is often rendered obscure by the metaphorical manner in which he expressed his sentiments, seems to have attributed the sorrow of child-birth to the changes effected in women by unrestrained indulgence of the passions, and intellectual cultivation. To this explanation we can only add a few illustrative observations. It is ascertained that the ganglionic system of nerves supplies the parts subservient to organic life, in which may be included those ap. propriate to the re-production of the spccies, with the sensibility necessary for the execution of their functions : excitement of this sensibility is not directly perceived by the sensorium, or, as the French physiologists expressively term it, the moi, so as to give rise directly to either pain or pleasure. Thus, notwithstanding the delicate sensi. bility of the stomach, the digestion of the food is not attended with conscious perception. When this does take place, from the functions of organic or nutritive life, it is because, from inordinate impressions, the sensorium is also excited. Sometimes impressions on the brain are also made by the ganglionic system of nerves, that induce volition without either pain or pleasure, (or it is so slight, perhaps from habit, as not to be very forcible,) as in the expulsion of the urine and fasces. Excitement of the cerebral system and an effort of volition, appear to be necessary, in persons subservient to our habits bf civilized life, for the expulsion of the contents of several of the reservoirs of the cicrctory matters of the body ; it is evident with rcspect to the bladder 2 238 Foreign Medical Science and Literature. and rectum; for, in some cases of apoplexy and palsy, when all (he functions of organic life, especially digestion, chylification, and the secretion of the urine, are carried on with the ordinary vigour, retention 6f the urine and fasces will take place, not from any inordinate material obstruction, but because the sensorium is not excited to direct the act of volition to aid in their expulsion. That the same excitement of the sensorium is necessary to procure the expulsion of the foetus from the uterus, seems to be evident; but this is effected in the savage, as well as in wild brute animals, with but little or no pain, any more than the evacuation of the feeces. It may be doubted whether or not this excitement of the cerebral system in the cases above mentioned, occurs in the savage; that iSj whether or not it be a natural law in the animal economy ; since the urine and feces are sometimes evacuated during sleep, without dream, ing, by children; and uterine action is known to go on in parturient women during sleep, (it should be here observed, that this is not accompanied with any action of the abdominal muscles,) and foetuses have been expelled from the uterus after the cessation of the functions of animal or relative life. This question does not affect our ex plana* tion, since such a connexion of cerebral with ganglionic nervous energy does take place in ordinary circumstances in civilized life; and if it be not a primitive natural law, the influence of the cause of the pains of child-birth we are about to designate, is only the more forr cibly shown. This is the inordinate sympathy and synenergy that civilization has produced between the nervous systems of organic and of relative animal life. Impressions on the former of these, that produce but little excitement of the latter in the savage, or one whose intellectual faculties have not been much developed, cause intense suffering and action in persons whose cerebral system has acquired that superiority in the human economy, which is produced by our habits of society and our mental cultivation. This is evident in a multitude of facts. It may here be sufficient to point out the extreme bodily injury savages will undergo, without showing signs of much pain, and their almost absolute freedom from insanity; whilst a little disorder of the stomach or liver, in persons in a state of civilization, especially those in whom this is carried to the greatest degree of reiinement, will frequently be productive of mania.
Applying this principle to parturition, we would say, that the call made by the uterus in that act on the cerebral system, which in the savage is either not experienced, or so slightly perceived as only to cause an effort with no more sensation of pain than what ordinarily takes place in the expulsion of the fasces, produces in the woman of civilized life, in whom indulgence of the passions and intellectual cultivation have caused an inordinate development of cerebral energy, the pain and other serious accidents they so generally endure. This, then, is the view we are disposed to take of this phenomenon.: Could we indulge in a more detailed explanation, it might be rendered more apparently correct; but we arc contented with pointing out to others what we believe to be an interesting course of enquiry, and one that, if pursued, might perhaps lead to some useful results. Before Dr. Dewees on the Pain and Difficulty of  ire conclude, it may be useful to observe, that these notions are powerfully supported by the observations of Mr. Power ; whilst they seem, in return, to elucidate the view.he has taken of the same subject.
We will now consider the essay of Dr. Dewees ; and, in the first place, the explanation he advances of the same phenomenon. He commences with remarking, that a change has obviously taken place in civilized life, by which parturition is rendered an act of difficulty and danger ; and he states his object in this essay to be, " to show in what some of these changes consist, and how to ameliorate them." The causes of difficult and painful labours, he continues to re-mark, may be divided into two general heads : those arising from some imperfection of the pelvis, aud those which interrupt the natural and healthy functions of the soft parts. It is to the latter which his attention in this essay is confined.
The author, in the first instance, gives a brief account of the opinions of Dr. Hunter, Malpigiii, and Ruysch, respecting the arrangement of the muscular fibres of the uterus, notices their discre* pancy, and then observes, that the correctness of neither of those descriptions has been satisfactorily proved. Since then, he continues, anatomists have never been able with their knife to clear up this point, we must have recourse to other means to satisfy ourselves : the only certain one, it appears to me, is, to deduce them from the actions of the uterus itself; this at least warrants two distinct sets, the one circular, the other longitudinal." -This, it must be well known, was the opinion of VesAlius, though he also supposed the existence of transverse fibres.
The basis of the arguments of Dr. Dewees is by no means a valid one for such a deduction, and will not be so admitted at the present time, when physiologists are not disposed to limit the property of contractibility to muscular fibres ; and it is not well ascertained that the chief actions of the uterus are expressly longitudinal, and transverse or circular. Many observations, especially those made when the placcnta has been attached to unusual parts of the uterus, and when there has been two or three children in it at the same time, seem to show tha^ like the stomach, it performs numerous varieties of action, according as it is irritated in one part or in another. Such actions are shown to take place in the stomach by the expulsion of substances from it, by ?omiting, that are not adapted for digestion, whilst alimentary matter is retained.* Let us for a time, however, admit of the supposition of Dr. Dewees, since the establishment of this forms the basis ofchis dissertation ; and, if we do not acknowledge it, we cannot readily proceed with him in kis enquiry.
Taking for granted, then, the existence of longitudiual and trans, ?erse muscular fibres in the uterus, the author next proceeds to state, that " he cannot help regarding the neck of the uterus as a distinct and independant part from the body and fundus, and as having its * See our review of Dr. Lallemanb's Thesis in the fortieth volume ?f thifr Journal, Many curious facts of this kind are there noticed. 24d ? Foreign Medical Science and Literature. own peculiar laws and actions; and (hat this separation of powers is absolutely necessary to the explanation of some of the phenomena exhibited by health and disease, and the influence of certain agents on these parts. This susceptibility to diseased action cannot be well disputed, and is indeed generally admitted. Dr. Dewees next adduces a statement of all the circumstances, which he considers most concur to produce parturition with the greatest possible regularity. These arc, First, there must be a subsiding of the abdominal tumor; and, if at this-time a finger be introduced through the os tincae, we shall find the membranes alternately tense and relaxed : these circumstances are owing to the uterus now beginning to contract, and forcing the presenting part into the pelvis. " Secondly, there must be a secretion of mucus from the vagina : in some instances this flows from it, several days previous to the onset of pains; but, for the most part, it only happens a few hours before they are felt. This mucus is secreted from the surface of the vagina, and perhaps from a portion of the neck of the uterus. Why these glands are excited to this duty may perhaps be difficult to explain, byt their action appears intimately connected with a certain state or condition of the os tincce: thus we find, ceteris paribus, this secretion to be most abundant where there is the greatest disposition in the mouth of the uterus to dilate or relax ; and with this is connected the same disposition of the perinaeum. It must be observed, that the secretion here spoken of must uot be confounded with leucorrhcca, as this discharge is by no means favourable to this effect. 44 Thirdly, the mouth of the uterus must yield easily, that the contractions of the body and fundus may not be exerted for too long a time unavailingly. The dilatation of the mouth of the uterus, when best performed, is either before or very quickly after, the painful contractions of the uterus have taken place : this, in general, is done without the mechanical aid of the contents of the uterus. *' Fourthly, the body and fundus must contract with sufficient force, to make the child pass through the pelvis.
Fifthly, the perineum must unfold without much or any mechanical force, that the child may not be detained in passing through the os externum. " Sixthly, there must obtain between the foetus and pelvis a proper proportion, and the former must be well situated, that it may derive every advantage from the circumstances just enumerated." In his observations <?:i the dilatation of the orifice of the uterus, we meet with nothing either novel or particularly remarkable: his chief object is to show that, " in the most natural and favourable cases of labour, the mechanical power of the ovum has no influence in dilating the mouth of the uterus." This is generally admitted, and Dr. Dewees might have spared his disquisition on the description of Baudel<<que; for that author, in his own language, advances the same doctrine. He next considers " the different kinds of contraction of the uterus.'1 "First, the longitudinal contraction : this is performed, by -the fibres Dr. Deweos on the Pain anef Difficulty of  Ihe uterus, 89 called, #r tHse $brps uftyph run from the fundus the neck; it served to shorten thp utprup in t^e direction of thp|q fibre? ; consequently, toptposo its contents morp a?d mpre, by making them approximate the mouth; and this wjl| be in proportion tp the diminution of resistance at tjus-part, andjhe fore? with which these fibres may act. " The circular contraction. Thi? action jg performed by the fibres so named; they* ^ it were, fuq rpund the Uterus, commencing at thq fundus, and terminating in the circle fprming the neck : they tend tq diminish the capacity pf the uterus in the direction pf its transrer?(j diameter; conscqpentfy, haTe little or no immediate agenpy in e*pplT ling its contents. " The simple contraction, or when either of these sets of fibre? acf separately, as, before labour especially, when the finger js iptrOfluce<| through the op {incae, we find the mpmbranes alternately tense and re* laxed, Jnttys, we, we presume, the longitudinal fibres act alone,. as there is no stiffening of thecjrcle forming thp njouth; or, as when th^ waters have been evacuated, the utpru? is P*ade to embrace its con, ^entfu and po pain for a, long time is produced? we suppose, in thi? instance, the.circular fibres act alqnifj as there is pp effort tp expel fjppteots of the pteros, whieh would not be the case didtfye longitudinal fibres co-operate with them. ?" Compound contraction, pr whpn bo(h spt$ of fibres apt, , T/jeir united action is proved, we conceive, when there is a hardening of th? ^no^th of the uterus, and an evident depression of this yiscus, with it? <;pntents, into the Jower part pf the pelvis-if4-Tonic contraction. IJy this we understand that uniform action ^yhieh thp uterus exerts to reduce itself. tp it? priginal size? thij apr ?>ears tp be the cfl'pct of all thp fibres folding thewsejyps np after th? jljstvapting pausp is rpmovpd^ , "Thp spasmodic, or that contraction of the uterus which i$ for th? $npst part ^ccompaoipd with pajp. {t njust be remembered, howpvpr, fhat pain does pot necessarily belong tp this species pf contraption^ since some wppiep are delivered without it. We should therefore, ^grpeably io )tw# fapt, rather call this species the alternate cpntractio# of thp uterus, as it has a greater or Jess intpryai between eacfr contraction, Vyhpp this actipn is best performed) it is, WC presume, chiefly by thp longitudinal fibres. " |t may here become a question," ppntipups the author, " how ar? thp fibre* of thp uterus enabled to perform this alternate contraction ? $i?ce wp know that a muscle, after haying contracted, cannot repeat that contraction, without being first relaxed, and then elongated." Wp $ hall not follow him in his remarks on this point; it has pp <?Lrec|; ^pnne^ipn with thp question und?er consideration, and we are desirous to give as clear and direct an exposition of his arguments in favour of his hypothesis, as his desultory manner will permit. It sho;>M he remembered, that the existence of muscular fibres in the utprus is aoi determined; that membranous contraction Will proceed without Intervals of relaxation; and that the tonic and spasmodic mode pf action, which the author enumerates,, spppj, vvith.ths ftid 9/ tfep ai>4owo. 247. 2 i 242 Foreign Medical Science arid Liter at art. 1 *"|U tninal muscles, sufficient to explain all the consequbhces observed in the mcchanism of the act of parturition.
The authdr then considers " the relative strength of the different sets of fibres:' he says, 44 We have already observed, that the longitudinal fibres were stronger than the circular : our reasons for thinking so are, " First, that, were they of equal strength in all parts of the uterus, delivery could not take place, since the circular fibres would embrafcd the body of the child, and thus retaiu it; their action 'being, as we have already said, to diminish the uterus only in its transverse diameter^ fconsequently, is at right angles with the longitudinal. and much pain endured, frdm this circumstance: it however yields eventually, and from the same cause and in the same manned as thd mouth of the nterus does at the Commencement of labour. <c Sixthly, When the painful Contractions take plaCCj the presenting1 p4rt is pushed lower into the pelvis; but, whCn this ceaScS) it most frequently recedes a little.
; If rom these facts, the following inferences, we thittk, are deducible: ** First, that the circular fibres may contract to almost any degree^ Without being attended with paih. 44 Secondly, that their contraction alone, however violent, does toot forward the child. ** Thirdly, that they do not possCsS the power of alternate contract tion in the same degree as the longitudinal fibres ; and, that they may exert this power, it is necessary at first to hare them distracted by some force or other.
; ? " Fourthly, that the pain felt during labour must, in a great mCasnre, if not entirely, depend upon the contraction of the longitudinal fibres.
Fifthly, that the changes the Uterus has suffered from civilization artd refinement, must be chiefly confined to its longitudinal fibres, " From What has been said, then, the spasmodic or alternate contraction of the uterus appears to be nothing more than an increased effort it makes to overcome the obstacles opposed to its progress to a State of Vacuity ; and that the pain attending these Contractions depend upon certain physical changes which the longitudinal fibres have unw dergohe from the causcs just mentiohed. Why a particular set or fiven direction of fibres should have suffered more than another, May e impossible to determine; but that they have, we believe to be most Certain. This change, however, is by no means confined to the uterus, as every straight muscle of the body appears to have participated with Jt; since it is admitted that the man of the civilized world has lost much of his original strength. On the other hand, the circular musw del, as far as we can determine, have lost nothing of their primitive power; since it is more than probable that the various sphincters,* among which we may reckon the circular fibres of the mouth of tho wterus, perform their duty as effectually and as powerfully as in the time of onr first parents. , " > " Do not these facts emphatically account for women, who huv* suffered these changes, having more tedious and painful labours than those who have not undergone them ? as the women of Savage nations, the women of Calabria, &c. and without the necessity of having tem * The heart, or intestines, may also be included.
Dr. Detfe&s on t&e Pain and Difficulty of Chili-birth. 24$ course to a physical necessity, defied from th? erect position of man, ?Y the peculiar construction of ihe pelvis ?"* AfRhe postulates in the foregoitig arguments are mere suppositions^ rot rendered at all probable by precise observations. The only fact$ thal dfcem to be well established are these, that the uterus may be partially excited to contraction, which contraction does not so well teat! to expeHts contents as that which occurs when it wholly embraces them, as the hand does a ball; and that a certain degree of contraction may take place in it, and that not to be easily overcome, without producing pain : in this case, it seems, the cerebral system is not excited, fat no action takes place in the abdominal muscles, which always occars when that is excited^ and it is therefore easy to understand why* during this partial and merely tonic contractility, but little or nothing Is done towards the expulsion of the foetus. Whether a particulaf and direct longitudinal action of the uterus ever takes place, and, If so, if it be always accompanied with pain, remains to be de* tided-,4 and, we repeat, the author has not rendered his assertion at all probable. What he considers as the expressly longitudinal action of the uterus, is, very likely, merely a continuous grasp of the whole organ, which, through the medium of the cerebral nerves, produces a concurrent action of tho abdominal muscles, and is thus so particu.
iarly efficacious in forwarding the progress of the fcetus. The reason why the foetus recedes a little on the cessation of this " longitudinal friction,'* is, that the abdominal muscles have ccascd to act, as well as perhaps, In some measure, the uterus.
The conclusion which the author draws from all these pure suppo-i.
Sitions, is not a little singular, and his corollaries to prove it are not Corrcct. Wc have no evidence of the existence of that want of balance between the longitudinal and circular muscles of the body; and our women who are engaged in active exertions,?for instance, the stout and hardy Welsh women who visit the markets in the midland countici of England with their agricultural produce,?are much stronger than most female savages; whilst they suffer as severely during labour as any whose minds are equally cultivated by social intercourse. But, \ye suppose, the patience of our readers must be exhausted ere this, at seeing medicine so sported with, by having Visionary data, inaccurate arguments, and almost ludicrous deductions, intruded in the place of that logic, which this science has at length effectually claimed, and which every judicious physician is disposed to revere.
The author, after this, treats the subject of difficult parturition in a fnorc practical manner. But, as we do not comprehend his principles, We shall not enter on the consideration of the application of them. Every thing is reduced to " rigidityHe says, il The cause of pain and difficulty, for the most part, depends upon a Certain condition of the soft parts that are subservient to labour; we sh&tf therefore consider this subject under the following heads:. " First, where rigidity of the mouth of the uterus depends on the circular fibres maintaining their contraction for too long a time, but where no inflammation attends. * Sec Osborne's Essays; also Med. Mus. vol. i. p. 270.

246
Foreign Medical Science and Literature. m Secondly, where the rigidity is attended with inflammation. " Thirdly, where the rigidity arises from previous local injury, either from mechanical violence, or from inflammation, and its consequences. " Fourthly, relative rigidity, or where it proceeds from disproportionate powers between the longitudinal and circular fibres.
?" Fifthly, tonic rigidity, or where the circular fibres remote from the mouth embrace the body of the child too powerfully." The remedial measures which the author examines the efficacy of, are opium, the warm bath, and blood-letting. On these-subjects he does not appear to us to hare advanced any remark of particular no^ velty, except the inculcating a very free use of blood-letting to aile* viate this rigidity. The work terminates with some observations ot| the efficacy of ergot (the secale cornutum) in cases of 44 difficulty from want of force in the uterus," &c. We shall not now dwell oil this subject, since this remedy in general, and his opinions respecting it? use, have been already noticed at length in various parts of thi$ Journal. (Continued from p. 166.) We have now to adduce the general conclusions of M. Breschet on the pathology of inflammation of the veins, and theiappropriate measures for the relief of that disease. As these consist of observations rather than opinions, and are drawn up in a concise and perspicuous manner, we shall give them in detail, and without any particular re. majrks, as the accuracy of the author's descriptions, and the utility of his labours, must be sufficiently apparent. Dr. Breschet observes, that V Inflammation of the veins may be cither idiopathic, sympathetic, symptomatic, or metastatic. " Physiological characters of inflammation of the veins.?The signs of inflammation of the veins are not always easily recognized ; particularly if the inflammation is seated in the small vessels, or even in the trunks, when they are situated in the visceral cavities.
lp. Local characters.?The consideration of the precursory circumstances ; pain in the course of the veins ; swelling of the adjacent cellular tissue; sometimes redness and tension of the skiu; its sensibility and shining appearance in the passage of the vein; and after* wards a kuotty, tense, and painful cord, in the particular direction of the vessel; are the most ordinary phenomena of this inflammation. If a wound exists, there may be an evacuation of blood altered from its usual appearance, or of pus more or less thick in consistence, from the orifice of the vein. In the latter case, soon after the lesion of the vessel was effected, there is pain in the wound; swelling comes on ; the wound does not unite by the first intention, its edges become hard; or, if it has cicatrized, an abscess forms under the cicatrix, and soon destroys its continuity, 'lhe pains which occur in the course of the.
Dr. Breschet on Inflammation of the Veins.

647
Inflamed vessel are mote particularly directed towards the heart than towards the extremities; they are augmented by pressure, and thejr have sometimes been supposed to be rheumatic. A sensation of.burning'heat fallows exactly the samedirection as the pain.
.v>< General characters.?It is rare that inflammation of a vein, especially if it has existed some time, is not accompanied with disturb, a nee of the system, or a real febrile state, the intensity of which varies according to that of the inflammation, the extent of the disease, its seat, the importance of the vessel, and the.tendency of the local affection to one or other mode of termination. It should be remarked, that many physicians-have observed in these circumstances the phetio^ meria of typhus ; and 1 have myself found, in many subjects who had fallen victims to typhus, evident traces of inflammation in the encephalic veins and in the venous sinuses of the cranium. The duration of inflammation of veins is occasionally very short; most frequently, it is of rather long continuance: and it appears, from the observations of M. Fizeau, that this phlegmasia may be. remittent, presenting actual paroxysms of exacerbations of the symptoms.
" Inflammation of the veins may be confounded with that of the arteries, the lymphatic vessels, or of the nerves. In the flrst case, the pain and the other external characters are directed from the point where the artery has been injured towards the branches of the vessels In the second case, the pain may extend in the direction towards the heart, but the .lymphatic glands swell, become painful, and the skiu often presents two or three red waving lines, which appear shortly after the lesion or pricking of the vessel; and it is not long before tumefaction of the whole member takes place. 44 Lastly, if the nerve be the seat of the malady, the pain is propa. gated from the situation of its origin to a common centre, and especially from the situation of its ramifications: it is instantaneous; it immediately follows the puncture; and this pain has varieties of character, as we observe in the neuralgia, which are often only chronic inflammations of the nerves. " Anatomical characters of inflammation of the veins.?Inflammation of the veins may terminate in several ways.
We do not possess well.authenticated facts to prove that it, in any cases, terminates in resolution ; and that the vessel, being restored to its former state, executes the functions for which it was primitively adapted. Union of its parietes, obliteration of its cavity, suppuration, ulceration, and gangrene, most commonly take place. Thus, phlebitis appears under the following forms: 1?, adhesive inflammation; 2?, suppurative inflammation ; 3", ulcerative inflammation; 4?, gangrenous inflammation; 5climinatory inflammation. Dvpuytren think that adhesive inflammation may exist in veins; and it is indeed by that, that wounds of these vessels are healed in fourand-twenty or six-and-thirty hours. We must, however, distinguish the cicatrization of the external tunic of veins from that of their In. ternal membrane: the former, when it is divided, unites in the same manner as wounds of the cellular tissue; but this is not the case with 2 $48 Fa reign Medical Science and JMewlUre, the adherence of the internal membrane; U take# place more remote^ and with more difficulty* from inflammation l#fcft readily affocting thi# tissue. The cicatrix ofdeletions ot continuity of the jwriotes of remains but weak far ?ome time, awl is easily torn? Twelve op twenty-four hours after blood-letting, we can, by slight peroussipn. or by distension, destroy the union that has been effected. It. is even by these that the adhesive inflammation is changed into the suppurative, and is propagated to a greater or less extent in the cavity of *h# TSW?> And sometimes to the heart. i , "John Hunter, however, considered the adhesive inflammation of veins as a mean of arresting the progress of the inflammation; and he aays, that, by compression excited on the sides of the veip$> we. may cause them to adhere, and limit the extent of the disease, by preventing the pus formed. below the adhereoce extending further towards the heart. Mr. Travers believes, on the contrary, that this adhflsi** inflammation is rare in veins, that a considerable degree of ifritatfo* is necessary to provoke it, and that, when inflammation ia developed, it passes rapidly to suppuration ; or else that a large quantity of ?0?r gu t able lymph is effused into the vessel, which fill* up its calibre* obliterates it, and at length becomes adherent to its parietes: but here there is, properly speaking, only adhesive inflammation, only that there should not be so abundant an effusion of eoagylable lymph.
"? The little disposition to adhesive inflammation offered by the iftteiv nal membrane of veins, seems to oppose the analogy that has been ?opposed to exist between that and the serous tissue. "2P. Suppurative inflammation*?-11 is very common in veins; th# greater part of the observations that we have referred to, demonstrate its existence. This species of inflammation has a great disposition to extend further and further on the affected surfacos, and the p.Ms mingled with the blood in its circulation with the eoHtieoity of the tissues, is a powerful agent in its propagation. It is in these cirfiWffl* stances that the general phenomena assume their severity of character, and that the state of the patient becomes calculated to excite the mwt serious alarm. If the Inflammation diminish, the p#P, from ichorous, serous, or white and consistent, as it had been, is changed/or an ajbatminous fluid, and secondary adherenoo or obliteration of the vessel it death, the tuinor was found to contaiu gangrenous cellular membrane and blood in a state of putrefaction. The internal jugular vein vu filled, to a certain extent, with a coagulutn of blood; but below , thl* there was an ulceration that hail established a communication with th* sac of the iumor, so that the, blood which ca?c from the head.pas&ed Dr. Breschet on Inflammation qf the Veins.
($49 in part into the cyst ; 'there was an ulceration ateo that had 'induced a communication of the cyst with the cesophagus, so that the contents of the tumor could pass into the intestinal canal.
-**. Jthas been frequently observed, that, if wounds of the Jrerns have not united by the first intention, the suppuration that is formed either in the tunics of the vessel or in the adjacent tissues, was soon accompanied with inflammation of the edges of ;he wound; that the opening gradually increased in size; and that it was not rare to see the whole circumference of the vessel destroyed by this vessel, and the continuity of its canal cease to exist, by.the .progress of the ulceration. Lastly, many instances of ulceration of the internal membrane of veins have been observed, but without the perforation: of the whole thickness of the parie'es of the vessels, 4P. Gangrenous inflammation.?The frequency of suppuration of veins leads to a belief that gangrene might readily affect these vessels : observation, however, demonstrates the contrary. The veins and arteries long resist the effects of the gangrene which destroys all the tissues in the midst of which they may be situated. These vessels are, however, not in-a htalthy state ; inflammation has seized them, and ail abundant quantity of albuminous matter, mingled with a little blood, fills them, obliterates the canal for a greater or less extent, and thus opposes the occurrence of hemorrhage. A t length, the vessels, isolated on all sides by the destruction of the other tissues, and no longer receiving nourishment, die by a sort of inanition; a process is set up In so'ine point, but alwa/s below the termination of the coagulum ; the part of the vessef despoiled of its ad jacent parts is separated ; and this inflammatory process, by which parts deprived of life are separated from others, is that which I term, after M. DupuYTitcv, the elinti-' natory inflammation. <{ t*?. The eliminatory inflammation.?When a ligature has been placed on a vein or an artery, it is by this eliminatory inflammation that the vessel is separated throughout the whole thickness of the line embraced by the ligature, by which this is also detached, and by which a portion of the vessel forms a real eschar. In an artery, if the ligature be not too large and is properly applied, a moderate degree of inflammation affects the vessel above and below it. A slight effusion of icoagulable lymph takes place on its internal membrane, and adhesion by.the first intention is the result; a coagulum of a conical figure, albuminous at it's base and sanguineous at its summit, is found, near the adherence of the sides of the vessel, to oppose the effort of the blood; and, by eliminatory inflammation, the artery is gradually destroyed in the point correspondent to the ligature, which at length is detached. This happens from the tenth to the fifteenth day, if the vessel alone has been comprised in the fold of the thread, whatever may be its nature; but this is longer in taking place, if the thread does not act immediately on the ressel, and if it comprehends fibrous parts. The coagulum is not adherent to the internal membrane in the firsit few days; but, by an inflammation that takes place in the tissues of the vessel, it terminates by forming an adhesion. 44  Foreign Medical Science and Literature? the points adjacent to the ligature, and when the coagulum is not yet adherent, haemorrhage may occur; and, if a ligature of reserve be employed, we easily divide the whole of the parietes of the artery in a point where the coagulum does not occupy the whole calibre of the vessel, and where it consequently cannot adhere to the internal membrane. This section of the arterial parietes by a ligature of reserve is effected more promptly in proportion a9 the inflammation has made the tissues of the artery lose their resistance, and permit themselves to be divided like parts affected with the sebaceous degcnerescence. These observations on the mode of resistance of inflamed tissues, and on the true causes of consecutive haemorrhages, appertain to ML Duvuytren. I have often had occasion to verify their justness and importance.
If an haemorrhage happens a short time after a ligature has been placed on an artery, it is not immediately above the first that a second should be applied, but on a distant point, where the arterial parietes are not inflamed. Has a large ligature been applied on an artery? the section of the vascular parietes has not been effected, and union by the first intention is not effected; it is the suppurative and ulcerative inflammation that then ensiles; and, when the whole thickness of the vessel has been destroyed by this process, haemorrhage is the consequence. " It is not exactly thus with respect to the veins. Adhesive inflammation being excited with more difficulty in these vessels, and their internal membrane not offering the same facility of division as that of arteries, adhesion by the first intention does not take place, or only with great difficulty. The facility with which the tissues of veins are distended with blood, is another unfavourable circumstance to the primitive union. A more powerful and a more durable irritation is necessary to induce inflammation of veins. Albuminous matter alone is secreted if the inflammation be moderate, or else to this secretion is joined the formation of pus if the inflammation be intense. When the inflammation extends on one of the surfaces of the vessel, either from the force of the irritation that has acted on it, or because the pus has circulated in the part of the vein which is between the ligature and the heart; and it is, without doubt, to this propagation of the inflam. mation, that the development of general symptoms, the severity of the disease, and often the death of the subject, is to be attributed. " The part of the vein situate near the ligature inflames ; the membranes of the vessel acquire an inordinate thickness ; the canal of the vein is filled up, and to a great extent, with a concrete albuminous matter, which soon adheres to the vascular parietes, and renders the vein impervious to the blood. The ulcerative and eliminatory inflammation then divide the whole thickness of the vessel in the circular line embraced by the ligature. fi The treatment.?It should be directed by the same principles as that of other inflammations. We should first endeavour to ascertain its cause ; and, if it has happened after venesection, determine whether or not the instrument has been broken, and the point of it left in the parieties of the vessel.
Prof. Lauth on the Stmcturc of the Brain. 251 <l When the inflammation is solely local, we have been advised to put a stop to it suddenly, in its commencement, by cold lotions or fomentations,?as ice and saturnine applications. W hen the disease is more advanced, it should be combatted by the application of leeches on the course of the affected vessel; relaxing fomentations; emollient cataplasms; oily and mucilaginous unguents; tepid baths; camphorated, opiate, and narcotic, topics. " J. Hunter, Reil, and Mr. Abeknethy, think that we should, and that we may, incite adhesive inflammation, above and below the part affected, to oppose the extension of the disease, and prevent its extending further and further up the venous trunks, and to the heart itself. This adhesion would also prevent the pus, circulating with the blood, from irritating the internal membrane of the vessel over which it might flow. From what I previously said, it will appear that we cannot depend on the effects of compression in exciting this adhesion, because it is very difficult to obtain adhesive inflammation in the veins. u A more certain mean would be to cut the affected vein through transversely, at a certain distance from the seat of the disease, to break the continuity of the tissues, and thus oppose the propagation of the inflammation. We may conceive that this operation is practicable only in cases where the affected vein is not very large in calibre, readily accessible to instruments, and when we need not fear the wound, ing of an artery or an important nerve.
" Prudence requires that, in the operation of phlebotomy, we always endeavour to obtain union by the first intention of all the different parts interested; and, if new emissions of blood are desired a short time after the first, that we do not destroy the process of primitive cicatrization to obtain blood by the same opening, but that we make another in a second part, and, if it be possible, in a different Tein.
" If the inflammation has terminated by suppuration, we should, without delay, open the abscess to obtain a free course for the evacuation of the purulent matter.
" Lastly, if general symptoms appear, and they are intense, we should combat them by all the means directed for the treatment of angeio-tenique (inflammatory) fever and the phlegmasiae."?Journal comp. du Diet, des Sciences Medicates, tome iii.
An Account of the Structure of the Brain and its Appendages ;* by G. Lauth, Professor to the Faculty of Medicine at Strasbourg.
[From the Journal comp. d\i Diet, des Sciences Medicales, tome iii.] The brain, or encephalon, is the organ contained in the cavity of the cranium, termed by the ancients the superior venter. In order * The numerous discoveries which have been made duting the last twenty years, respecting the brain, including those of Gall, lias rendered necessary a new description of that organ, which should comprise the discoveries of the physiologist we have named, without being subservient to his doctrines. This task has been undertaken by Prof. Lauth, and we are convinced that our readers will contemplate with much interest the results of his labours.?Edit, 2K 2 25<i Foreign J\hdical Science and Literature.
to describe it completely, we shall commcnee,: by way of prolegomena, \tfith an examination of its envelopments, a description of its different" substances, and the denomination of its vessels. We shall also indi* cate the modes of dissecting it, and shew the divisions which we believe best adapted to favour the embracing in one view the numerous parts of which it is composed. > ^ 1. Prolegomena. The envelopments of the brain.?The cranium is covered externally by the hairy scalp and the muscle termed the epicranium, which furnish to this osseous vase a thin envelopment, above, in front, on its sides, and on its posterior surface. The cranium and the brain itself are, in consequence, much exposed to the intemperature of the air, to the consequences of compression, to wounds, &c. .The basis of the cranium is better guarded, being turned towards the ntck; it is united to it by muscles and strong membranous ligaments, and there is also much adipose tissue interspersed between these parts. The cerebral envelopments within the cranium, are the dura mater, a strong, fibrous, white, and vascular, membrane, which serves, ut the same time for an internal pericranium, and gives out various prolongations; as, the falx, situated between the lateral parts of the brain ; and the tentorium, placed between the cerebrum and cerebellum. The second membrane is the araehnoidea, a transparent lamina, thin and "without blood-vessels, in contact with the pia mater over the whale of the surface of the brain, except at its basis, where it is a little separate from it, as well as over the spinal marrow. The pia mater,? or the third cerebral envelopment, is a thin vascular membrane, which immediately embraces the cerebral substance, and which penetrates into its interior, either in dipping into its furrows, or in introducing itself by openings: it receives, in the last case, the name of the plemt choroidts.
The substances of the brain.?Tn the embryo there is only a single cerebral substance, which, with the perfectionment of organization-, is divided into two matters, distinguished by their colour and their structure. The first is grey, and termed the cervical, because it occupies the greatest part of the surface of the brain, and enters into'its furrows, where it covers the lateral surfaces of its convolutions. The second is white, and bears the name of the medullary part, because it is often placed interiorly ; although several organs of the brain are white on the surface and grey within. These two substances are sometimes distributed in layers, so that the external grey part is not continuous with the internal white matter.
These two substances present various shades of colour in different parts of the brain. Malacarne* long since made this remark. Not inuch attention has been paid to the tints of the white substance; but those which the grey presents have induced Sqsmmerring+ and Gen-nari^ to admit a third, yellow substance; and a fourth, black. We, indeed, always find a blackish crescent in the crura of the brain; but the * EncefaMomia, P. ii. No. 15. t De Basi Enecpliali, paj/e 63. + Dc peculiar 't Structura Cmbri, p. 72, Prof. Lauth on the Structure of the Brain, 253 yrllow substance, which Scemmering says is evident, particularly ia that portion of the posterior lobe of the brain which rests on the tentorium of the cerebellum, and which Rolando* describes in the cerebellum, does not constantly exist, according to our own observations. There are some bodies where the deep-grey colour passes suddenly to white; wc then do not perceive the yellow : in dead bodies, on the contrary, where the grey gradually becomes pale, it appears yellow before the commencement of the white colour; as Vicq,J)'Azyr+ also remarked. Gall;}; believes the grey substance to be diversely coloured and modified, according to the different destination of the nervous filaments which are thence derived.
The grey substance of the brain is the softest solid in the human body. We perceive in it fibres irregularly disposed, which are for the greater part blood-vessels; because it takes the colour of the matter of injections, when we have succeeded in well filling the vessels with the latter. This circumstance led Ruysch? to imagine, that it was entirely vascular, and not formed of follicular glands, as MALpioi!j[j had believed. Albinus? modified the doctrine of Ruysch, saying that there existed a small quantity of grey substance incapable of being injected, interposed between the vessels, and forming the basis and the proper character of this part of the escephalic mass. The beautiful researches of Phociiaska** shew also that, in the grey substance of the brain, as well as in all the other solid parts of the body, there is a portion which can never be injected. Anatomists have n^t hitherto been able to separate the grey pulp from the fibres that sustain it, probably in consequence of the softness of the latter. The grey substance, always uniform, but more vascular than the white, should be considered as the preparative organ of the latter.
The white substance does not change its tint by the nicest injections, because it does not contain a sufficient proportion of bloodvessels. It presents in almost every part a fibrous aspect, which has led to an opinion that a white fibre is the true element of its structure. This opinion corresponds with that of the ancients on the structure of the nerves, which they termed the third vascular system. They arrived by degrees to the hypothesis, that the red blood-vessels terminate, in the grey substance, in grey vessels, which themselves became white canals, composing the white substance and the nerves. This doctrine was particularly developed by Boerhaave.-H-Modern anatomists no longer admit, it is true, a tubular structure in the white substance; but its fibrous formation appeared indubitable to Haller^J: 254-Foreign Medical Science and Literature. Malacarne,* Scbmmering, Monro,f Vicq-d'Azyr, J Gali,$ Rolando, || Reil,1[ Carus,** Meckel,ft and Wenzel. J J Notwithstanding these respectable authorities, it will be evident, from reflection on the ensuing details, that the fibrous aspect depends on the presence of a membrane, and that the white substance itself is pultaceous, semi fluid, and not solid. We have seen it thus in trepan, ning a man who had received a gun-shot wound in the head, whose brain escaped through the fractured skull and toru membranes. This substance constantly presents the same appearance after death. When a nerve is cut across, it is driven out by the contraction of the tunics ; it escapes from the white portion of the brain and from the spinal marrow, when the surface is slightly wounded. It receives its distinct figure from the membrane that sustains it, on which it is spread,-like colour on the canvass forming the ground of a picture. Any person may be convinced of this, by an examination of the encephalon, the spinal marrow, the nerves, the retina, and the terminations of the auditory nerve. This fine membrane is indeed so well known, that we arc surprised that authors have not recognized in it the general utility which we have indicated. Malacarne?? speaks of an epithelium ?which envelops the white substance, and which is a continuation of ihe pia mater. Yicq-d'Azyr|| j| found the taenia semicircularis covered by a firm, transparent, lamina. There is, according to Gall,? f a neurilema situate between the two medullary strata which form each circumvolution of the brain. Reil*** speaks of a fine membrane situate on the surface of the medullary organs. KEUFFEL-f-ff distinguishes in the spinal marrow, the white pultaceous substance from another, -which is fibrous and more compact. WenzelJJJ says, that the ventricles are lined by a membrane. The white substance is then composed of two elements: one, pultaceous, which is the essential part of it; the other, membranous, which gives solidity to the former, and causes the fibrous appearance which this organ presents.
We cannot quit this subject without speaking of the opinion which is in opposition to what we have advanced, and without giving an exposition of the researches of modern anatomists on the intimate struc. ture of the cerebral substances. inferior class. The more considerable these masses are, (he say*,) the more numerous are the nerves which spring from them. Now, these same conditions being present in animals of the highest class, we should regard these ganglions as the origin of the nerves. No nerve eomes from another nerve; but each takes its origin in its proper mass of gelatinous substance, which is the matrix and nutritive matter of the Berre.
Wherever the grey substance exists, we should suppose that there is the commencement of nerves ; and he who commences his descriptions by nerves already formed, proceeds in a way that is contrary to the laws of nature. What is more conformable to reason than to commence investigations at the same point where nature began her work ?
It was not ascertained that the nervous fibres owed their origin and support to the grey substance. The fibrous structure of the white substance, (says this author,) should be recognized as a thing demonstrated : besides, the idea of its being a pulpy matter contradicts all that is known of anatomical and physiological phenomena." Gall nevertheless acknowledges, " that the brain is composed of fibres of such a degree of delicacy, that it may be only a uniform mass." The cortical substance tends, according to Reil,* to the globulous structure, and the medullary part to a radiated structure. Wenzel 4-Relieves almost all the substances of the human body to be formed of round corpuscules, which are formed of a common cellular substance, and of another proper to each organ, and enclosed in the cells. He considers, with respect to the brain, the grey substance as the seat of sensation and of the particular function of each organ, and the white appears to him to serve as a conductor. The matrix of the nervous parts is, according to Cams, J composed of globules, which are the type of animal organization, and are disposed in lines and in membranes. The cortical and medullary substances only differ in consequence of the globules being disposed in right lines in the latter, whilst in the former they constitute a thick tissue.
Our intention is not to refute the opinions of others, and still less to enter into discussion with any person whatever; we shall, therefore, confine ourselves to the following observations. Persons versed in the use of the compound microscope, see the elements of the human body, and of bodies in general, in a globular form, as della Torre The vessels of the brain.?The blood-vessels, arterial and venons, tife disposed in a particular manner in the organs under consideration. The encephalic arteries* are derived from the internal carotid and vertebral arteries: the latter unite into a single trunk, the basilar^ artery, the branches of which form, with those of the carotids, thfe arterial circle of Willis, so that there exists a communication betweeit all the encephalic arteries. The spinal marrow receives its branches from the vertebral, dorsal, lumbar, and sacral, arteries. These vessels 'carry with them the pia mater into the cerebral substances: they trai verse, in the hemispheres of the cerebrum, and in the lobes of the cerebellum, the grey substance to penetrate into the white substance; but, in the corpus callosum, and in the crura of the cerebrum, the white substance is the first which receives them. The final arterial ramifications are so delicate, that they have not yet been filled with the matter of injections, which in the brain does not return by the veins. The lattert are formed by very thin tunics; they end in the sinuses placed between the laminae of the dura mater, of which those that receive the cerebral veins terminate in the internal jugular veins; the sinuses of the spinal marrow discharge themselves into the verte. bral, dorsal, lumbar, and sacral, veins.
Lymphatic vessels have not yet been perceived in the braiiii Monro;}; considered that it must possess them. CmncH;sHANlis? detected a lymphatic gland in the carotidian canal. He thenfce cotieluded that lymphatic vessels existed in the brain. Mascagni|| described and figured lymphatics in the membranes of that organ, bat hef could not perceive them in the cerebral substances.
Dissection of the Brain.?There are several modes of dissecting the brain : one consists in removing the substances by horizontal .and oblique slices; this method bears the name of Vesalius when it is practised from the upper to ihe inferior part, and that of Varoliur when we proceed from below upwards. The other mode of operating, that of scraping the brain with the edge of the scalpel, is necessary for the perfect development of the different parts of this organ. Malacarne and Gall recommended it. Both of them have practised it on the fresh brain. * ?; r-There are some circumstances in which it will be necessary to harden the brain before it is examined.
This may be effected either by boiling it in oil, or by macerating it for several days in alcohol, or a solution of corrosive sublimate or of alum, and afterwards plunging it for several hours in pure water, to diminish its too-great rigidity. The brain thus prepared is torn with the fingers and the handle of the scalpel, in following the direction of the apparent fibres. Reil points out the mode of proceeding on this occasion.

358
Foreign Medical Science and Literature. ~ superior pons occupies the centre between the cerebrum and ccrebel* lum.
The medulla oblongata, which rests on the basillary fossa, forms d continuation of the two pontes, as being connected to the posterior part both of the pons Varolii and the tuberciila quadrigemina. It is continuous with the medulla spinalis, which is enclosed in the vertebral canal.
The history of the encephalon and the medulla spinalis comprises also the description of the origin and of the structure of the nerves, which leave the cranium and the vertebral canal to be distributed throughout the body.
These organs exist for the most part in pairs, and are placed on each side of the axis of the body. The impairal nerves occupy the axis itself, and are divided into two equal lateral portions. All these parts, pairal as well as impairal, have consequently a symmetrical structure.
. The subject under consideration will therefore be distributed in the following manner: 1, The cerebrum, (pcripherical arrangement; department of the corpus callosum; department of tke crura cerebri; appendix of the cerebrum;) 2, the cerebellum ; 3, the pontes; 4, the medulla oblongata j 5, the spinal marrow ; 6, the nerves.
("To be continued.) A Memoir on Ileus, and on a particular Method of Treating it. By J. D. Brandis, Member of the Royal Society of Medicine of Copenhagen.
[From the Nova Acta Regicc Societatis Medica Hauniensis, 1818 ; as abridged in the Nouveau Journal de Medicine.] u In the year 1794, being at Brunswick, where I was practising medicine, I was called to a patient, who was attacked eleven days previously with ileus, and in whom the symptoms were most alarming, ?such as delirium, coldness of the extremities, hiccup, facies hippocratica; leading me to fear the near approach of death, and leaving less reason for hope, from many remedies having been used by physicians of eminent abilities. I recollected the method of treatment that Frederick Hoffmann had once seen employed by Naboth, and to the use of which he had only consented by a sort of condescension. The result was more fortunate than Hoffmann had expected. On cold water being administered several times a-day, in doses of two glasses, the trunk and feet being previously well covered, a copious sweat broke out, to which succeeded a tranquil sleep ; and the pain in the bowels, as well as the vomiting, had ceased. Naboth moreover stated, that he employed with success, in three cases, compresses moistened with cold water over the abdomen. Many other physicians, as De Haen, Chavasse, Stoll, and VanSwieten, had also obtained good effects from those means, in analogous cases. 1 consequently determined to have recourse to them in the one that was presented to me. I prescribed the use of an iced drink, and had the belly covered with cloths dipped in iced water. la a few hours the delirium ceased: twenty-Dr. Brandis's Memoir on Ileus.
C5g four hours afterwards tho extremities had recovered their natural heat, the hiccup was less frequent, the vomiting more rarely occurred, and gradually entirely ceased. Yet the constipation continued, notwithstanding the use of cold and warm enemas frequently repeated. The appetite was almost extinct, and the patient only took a little animai jelly mixed with ice. I prescribed opium in small doses, and the dccoction of cinchona also mixed with ice. The patient continued about seven days in this state. During this time the omission of the cold fomentations to the abdomen constantly gave rise to returns of the vomiting; so the patient himself desired their re-application. At length, on the seventh day, a copious diarrhoea came on: the cold fomentations were then suppressed, having become useless; and in the space of four days, with the aid of cold and nutritive food, the reestablishment of health was complete. " After such unexpected success, I placed my whole confidence in this measure, and my hope has never been deceived. I have applied cold fomentation on the abdomen of delicate women as well as of robust men, and I have found in it a sure and prompt remedy. I have used it in a man 68 years of age, on the eighth day from an attack of ileus, which left nothing to hope. This old man was cured, although there was in the inguinal ring a small and immobile herniary tumor, with gangrene of the portion of the epiploon, and the formation of an abscess between the abdominal muscles. " In 1814 I had, for the tenth time, occasion to experience the good effects of this method, conjointly with our celebrated Callisen and Dr.
Strom. " A woman, 22 years of age, the mother of two children, was subject to spasms of the intestines, vomitings, and colics, at every menstrual period. She was attacked with ileus in the month of January, after exposure of the feet to cold, towards the epoch of menstruation. She not only vomited all she swallowed, but enemas, prepared with assafcetida, were also thus rejected : to this symptom were added coldness of the extremities, obstinate hiccup, and a frequent small pulse, that led us to presage a fatal termination. After the sixth day I prescribed, in the first instance, some glasses of iced water and the tinctura the. baiaca, combined with two parts of the essence of castoreum. Four hours afterwards there was no amendment; the medicines had been rejected, and the symptoms were still more severe. I prescribed cold fomentations, and increased the dose of the anodyne tincture to thirty drops.
*' Six hours afterwards, the vomiting had only once occurred; the hiccup was less fatiguing, the extremities were warm. 1 directed neither glysters nor any other remedy proper to provoke evacuations, from the fear of exciting antiperistaltic contractions of the large intestines. I continued the use of the same means for four days : on the sixth day of this treatment the bowels were spontaneously opened, and the patient became convalescent. " It is of the greatest importance in the administration of this remedy, to insist on it with perseverance. In the first patient, the use of it was continued for nine days; in two others, during twenty.four 2 h 2 $CG Medical and Philosophical Intelligence. hours. I hare had recourse, with success, to the same remedy in many other affections, and particularly in very violent colics, and in dysentery without fever. " The good effects I have obtained from the use of ice in ileus, would not lead me to advise it in all cases without discrimination, and to the exclusion of all other means. 1 have seen, in one case, the extraction of a carious tooth put a stop to all the symptoms of ileus. A woman, about 20 years of age, was taken, at the time of her menses, with a very violent tooth-ach: some person advised to place a piece of very cold iron between the gums and the cheek ; the pain disappeared ; but at the same time the belly became painful, the extremities cold 5 the patient was seized with continual vomiting, and the alvine evacuations were suspended. Being called on the third day, I prescribed the use of ice, but with little advantage. The manner in which the disease had first appeared, furnished a special indication: the tooth was drawn ; all the symptoms were suddenly alleviated, and a few hours afterwards the bowels were opened without the aid of medicine.